POS0204 RETROSPECTIVE STUDY OF THE COVID-19 COURSE IN CHILDREN WITH RHEUMATIC DISEASES: SINGLE CENTER EXPERIENCE
Authors: Z. Kolkhidova, I. Nikishina, V. Matkava, A. Shapovalenko, S. Arsenyeva, M. Kaleda, S. Salugina, E. Fedorov, T. Pachkoria
Journal: Annals of the Rheumatic Diseases (2022)

Background The study of the features of the course and mutual influence of the new coronavirus disease COVID-19 and various rheumatic diseases (RD) in children can still give us new lessons, warnings and fears. Objectives To update the analysis in a retrospective study the course of covid-19 in children with RD based on the results of two years of the pandemic. To analyze the impact of COVID-19 on the course of RD in children. Methods Retrospective analysis based on data from single center. The study included patients with RD and confirmed COVID-19 for 2 years (2020-2021). Results Were registered 320 cases of COVID-19 in children with RD. 158 (49%) patients were asymptomatically infected, 162 (51%) had clinical symptoms. A detailed description of the groups is presented in Table 1. Clinical symptoms were fever (67%), anosmia (47%), rhinitis (34%), cough (19%), arthralgia/myalgia (16%), dyspepsia (5%), rash (2.5%), pneumonia (3%). In the majority of cases (98%), COVID-19 proceeded in mild to moderate severity. Hospitalization due to COVID-19 was required just in 5 cases. 2 children were admitted to the intensive care unit. First, an 11-year-old girl with sJIA with the history of recurrent episodes of MAS resolved by regular administration of canakinumab. 2 nd , a 12-year-old girl with Sjogren’s syndrome, who received Rituximab and 1 month later she developed the COVID-19 with MIS-like clinical picture, pneumonia with 25%CT lessions. Both cases have a favorable outcome. Table 1. Clinical characteristics of children with COVID-19 and RD Covid-19 with symptoms (n= 162) Covid-19 asymptomatic (n=158) Worsening of RD after Covid-19 (n=51/320) Sex (F/M) 96/66 109/49 33/18 Age, years (Me[25;75]) * 15 [9;17] 11 [8;14] 13 [10;16] IgG Covid-19 positive 91 126 30 IgM Covid-19 positive 8 6 4 PCR Covid-19 positive 106 48 22 Diagnosis of RD JIA non-systemic 110 104 30 sJIA 11 10 9 SLE 6 5 2 JDM 9 6 3 Scleroderma 8 15 3 Sjögren’s syndrome 8 6 2 Overlap syndrome 0 4 0 AIDs (CAPS, FMF, Behçet’s disease) 9 7 2 FOP (Fibrodysplasia ossificans progressive) 1 1 0 Treatment of RD NSAID monotherapy 23 27 4 DMARDs 107 125 29 Systemic glucocorticoids 36 29 13 bDMARDs 73 72 21 Etanercept 22 33 8 Adalimumab 15 11 3 Golimumab 12 3 2 Infliximab 0 1 0 Abatacept 9 7 3 Tocilizumab 6 6 3 Sarilumab 2 2 1 Canakinumab 3 3 1 Rituximab 3 3 0 Tofacitinib 1 1 0 Baricitinib 0 2 0 Immunoglobulin human normal (in last 6 month) 7 3 2 Duration of disease, years (Me[25;75]) 5 [2;8] 4 [2;8] 5 [2;7] Duration of treatment DMARDs, years (Me[25;75]) 4 [2;7] 4 [2;7] 4 [2;5] Duration of treatment bDMARDs, years (Me[25;75]) 4 [1;5,5] 3 [2;6] 2 [0,6;5] The activity stage of RD by the start of COVID-19 Remission 91 90 33 Low disease activity 60 49 16 High disease activity 11 19 2 Temporary withdrawal of DMARD and bDMARDs during COVID-19 58 8 18 Worsening/flare of RD 42 9 51 *- p&lt;0,05 The clinical characteristics of the patients are presented in Table 1. COVID-19 didn`t affect the course of RD in the 86% of pts. However, 15% developed a flare of the RD with average of 3 months after COVID-19. In this group for 13 pts (girls mostly F/M-9/4, mean age 15 years [9;16]), COVID-19 triggered the new onset of RD (non-systemic JIA – 4, Uveitis – 1, non-bacterial osteomyelitis – 3, systemic JIA – 2, Scleroderma – 2, Sjögren’s syndrome – 1. 12 from 13 these children had clinical symptoms on COVID-19. Whether this is Long-COVID syndrome or an independent RD is not known. Conclusion Our study suggests that the new coronavirus infection in most cases in children with RD, had mild or asymptomatic course, regardless of therapy with immunosuppressive drugs and bDMARD, except of 1 observation with the previous therapy of Rituximab. Worsening of RD after coronavirus infection developed in 15% of cases, regardless of its clinical manifestations. In 13 patients, the RD were started just after COVID-19. The explosive increasing of the incidence of a new strain of COVID-19 for a past month may change the current results and conclusions. Disclosure of Interests None declared